Pt Teaching thyroid disorders.

Levothyroxine (Synthroid) Synthetic T4 (HYPO)

pt teaching 1. take same time each day 2. retain from switching brands 3. have regular blood work done. admin: held if pt is tachycardic =>100 bpm, weight loss is normal.

Which interventions would the nurse include in the plan of care during the first 4 hours after a thyroidectomy? Select all that apply. One, some, or all responses may be correct.

Monitor for stridor or dyspnea. After a thyroidectomy, it is critical to monitor for stridor, dyspnea, or other symptoms of acute airway obstruction that may result postoperatively. It is important to inspect the neck dressing and the sides of the neck and behind the neck for blood that may drain in that direction by gravity. The client needs to be placed in a semi-Fowler position to decrease tension on the suture line. Vital signs need to be monitored every 15 minutes until the client is stable, then every 30 minutes for 24 hours. Although this may be a complication of this surgery, tetany will not occur during the first 4 hours after surgery.

skin conditions would the nurse expect when performing a physical assessment on a client with a new diagnosis of hyperthyroidism?

warm, moist, smooth

clinical manifestations would the nurse expect a client with hypothyroidism

cool skin, constipation, periorbital edema, decreased appetite.

long term effect of untreated congenital hypothyroidism?

Cognitive impairment

Which intervention would be included in the plan of care for a client diagnosed with hyperthyroidism?

Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism. With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite. 1. arrange for sufficient rest periods

metabloic manifestations in clients with hypothyroidism (2) pulmonary mani (1) neuromuscular (1) cardiovascular (1)

1. intolerance to cold 2. decreased body temp 1. difficulty breathing 1. impaired memory 1. decreased blood pressure

hyperthyroidism is being treated with propylthiouracil (PTU). Which instruction will the nurse include in the teaching plan regarding this medication?

1. avoid abrupt discontinuation ->thyroid crisis 2. monitor your weight, pulse, and mood-> increased weight/decreased pulse/ mood stability means therapeutic. 3. sore throat, joint pain, fever, or oral lesion-> infection

Which intervention would the nurse implement during the first 6 to 8 hours when caring for a client after a thyroidectomy?

Assess the sides and back of the client's neck for evidence of bleeding. In a back-lying (supine) position, blood will flow with gravity down the sides of the neck and not be seen. Positioning two pillows behind the client's head flexes the neck excessively and increases tension on the suture line, which may inhibit the passage of gases through the oral, pharyngeal, and tracheal areas. A small pillow behind the head keeps the head and neck in functional alignment and limits tension on the suture line. Seizures are a complication of hyponatremia and not a common complication of hypocalcemia. Although deep breathing should be encouraged, coughing should not be encouraged during the first 24 to 48 hours to limit stress on the suture line.

Which clinical findings would the nurse expect to identify when completing a nursing admission history and physical on a client with suspected hyperthyroidism?

Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen. Menstrual disturbances are associated with hyperthyroidism; women can experience lightened periods or missed periods. Thickened skin is associated with hypothyroidism and myxedema. An apathetic attitude is associated with hypothyroidism and myxedema. 1. palpitations, Tachycardia, missed menstural periods.

Hypothyroidism (what is the main vital thats needs to be monitored)

Respiratory rate.

A client with thyroid cancer is scheduled for a thyroidectomy. Which information will the nurse teach the client?

Thyroxine replacement therapy will be required indefinitely. Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent hypothyroidism. Increased intake of carbohydrates and proteins is needed because of the increased metabolic activity associated with hyperthyroidism. Chemotherapy is uncommon; radiation may be used to eradicate remaining tissue. A tracheostomy is not planned; it is needed only in an emergency related to respiratory distress.

Which condition would the nurse expect the client to develop if their parathyroid glands have become damaged during a thyroidectomy?

tetany The parathyroid gland maintains calcium and phosphate levels in the body. When there is any damage to parathyroid glands, there would be improper functioning of these glands, which may cause conditions such as tetany. Tetany is a condition in which there is hyperexcitability of nerves and muscles that occurs as a result of low calcium in the body (hypocalcemia). A goiter is caused by an enlarged thyroid gland. Globe lag is a condition in which the upper eyelid pulls back faster than the eyeball; this occurs in hyperthyroidism. Photophobia is a visual problem that may be seen in clients with Graves disease.

The nurse is caring for a client with hyperthyroidism. Which laboratory test will be most beneficial in monitoring the effectiveness of drug therapy?

T4 total FT4= thyroid func FT3= T3= diagnose hyperthyroidism

The client is prescribed potassium iodide solution before surgery for a subtotal thyroidectomy. Which explanation will the nurse give as to why this medication should be taken?

"It will reduce the risk of hemorrhage during surgery." Potassium iodide, which aids in decreasing vascularity of the thyroid gland, decreases the risk for hemorrhage. Thyroid hormone antagonists help decrease the body's metabolism. Potassium iodide does not regulate parathyroid function. Thyroid hormone antagonists help decrease the amount of thyroid hormones being secreted.

On the first postoperative day after a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports a sore throat when swallowing. Which intervention would the nurse take for this client?

Administer analgesics as prescribed before meals. Soreness is to be expected. A progression to a soft diet will provide nutrients needed for healing and energy and will stimulate the return of bowel activity. Analgesics as prescribed will reduce soreness during meals. Reordering the full-fluid diet is not within the legal role of the nurse. Soreness is to be expected; this is not an emergency necessitating medical action. The soreness is not because of drying; when the client is at home, humidified air might help reduce the soreness, but it will not help the client eat the soft diet. Gargling involves hyperextension of the neck, which may put tension on the suture line.

After a surgical thyroidectomy a client exhibits carpopedal spasm and tremors. The client reports tingling in the fingers and around the mouth. The nurse suspects a deficiency in which mineral?

calcium The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia. Deficits in potassium, magnesium, and sodium do not cause these classic manifestations.

thyrotoxicosis cause

overdose of exogenous thyroid hormone.

The nurse identifies which clinical manifestations as being characteristic of hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Diaphoresis/Weight loss/Protruding eyes Diaphoresis occurs with hyperthyroidism because of increased metabolism, resulting in hyperthermia. Weight loss occurs with hyperthyroidism because of increased metabolism. Bulging eyes occur with hyperthyroidism and are thought to be related to an autoimmune response of the retroorbital tissue, which causes the eyeballs to enlarge and push forward. Diarrhea, not constipation, occurs because of increased body processes, specifically increased gastrointestinal peristalsis. Heat intolerance, not cold intolerance, occurs because of the increased metabolism associated with hyperthyroidism.

Which clinical indicators are consistent with the diagnosis of hyperthyroidism?

Emotional lability/Dyspnea on exertion/Hyperactive deep tendon reflexes

A client is admitted to the hospital with the diagnosis of cancer of the thyroid, and a thyroidectomy is scheduled. What is important for the nurse to consider when caring for this client during the postoperative period?

Hoarseness and airway obstruction may result from laryngeal nerve damage. Laryngeal nerve injury can cause laryngeal spasms, resulting in airway obstruction. Parathyroid damage results in hypocalcemia, not hypercalcemia. Thyroid storm (thyroid crisis) is characterized by the release of excessive levels of thyroid hormone, which increases the metabolic rate. An increase in the metabolic rate increases vital signs, resulting in hypertension, not hypotension, and tachycardia, not bradycardia. Tetany is caused by a decrease in parathormone, a parathyroid hormone, not a thyroid hormone.

One week after beginning antithyroid medication for the treatment of hyperthyroidism, a client reports diarrhea, abdominal pain, and a fever. The client is admitted with a diagnosis of thyrotoxic crisis. Which intervention is appropriate to implement for this client?

PRIORITY: Reduce body temperature and heart rate. Immediate treatment in this emergency focuses on reduction of oxygen demands and thus cardiac workload to prevent cardiac decompensation. The need is for an increase, not decrease, in fluid intake to compensate for that loss because of the high metabolic rate. A response to sedatives is not likely because medications are metabolized more rapidly with thyrotoxic crisis; there is a danger of exaggerated effects of the medication with hypothyroidism. Clients with thyrotoxic crisis are more apt to develop hypoglycemia from the high metabolic rate.

In anticipation of a client returning to the room after a subtotal thyroidectomy, which intervention would be highest priority for the nurse to perform?

Place a tracheostomy set at the bedside. Thyroid surgery sometimes results in accidental removal of the parathyroid glands. A resultant hypocalcemia may lead to contraction of the glottis, causing airway obstruction; edema around the operative site also may cause an airway obstruction. Although not common, airway obstruction after thyroid surgery is an emergency situation. Oxygen, suction equipment, and a tracheostomy tray should be readily available in the client's room. Speaking is important to determine the status of the laryngeal nerve so having pen and paper available is appropriate. The semi-Fowler position is indicated to maximize respiratory excursion. However, a patent airway takes priority over these interventions.

Which are neurological manifestations of hyperthyroidism? Select all that apply. One, some, or all responses may be correct.

Exophthalmos/Blurred vision Blurred vision and exophthalmos are the neurological manifestations of hyperthyroidism. Fatigue is the metabolic manifestation of hyperthyroidism. Diaphoresis, or excessive sweating, is the skin manifestation of hyperthyroidism. Shallow respirations are the cardiopulmonary manifestation of hyperthyroidism.

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a "funny, jittery feeling." Which intervention is appropriate for the nurse to take?

Test for Chvostek and Trousseau signs and notify the primary health care provider of the complaints. These symptoms may indicate impending hypocalcemic tetany, a complication after removal of parathyroid tissue during a thyroidectomy. Physical assessment and notification of the primary health care provider are the priorities. These symptoms may be related to postoperative anxiety, but the priority is to assess for impending tetany. Taking the vital signs and placing the client in a high-Fowler position are not helpful for the complaint made by the client; further assessment for tetany is indicated. Requesting stat serum calcium and phosphorus levels is something the health care provider may do; contacting the provider is the appropriate response.

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative medication therapy with the client, which advice will the nurse include in the teaching?

"If you develop palpitations, nervousness, or tremors, the dose of thyroid hormone may need to be decreased." Excessive thyroid hormone replacement may lead to signs and symptoms of hyperthyroidism. Iodine may be administered before, not after, surgery. Thyroid hormone replacement is required for life. Propylthiouracil blocks thyroid hormone synthesis; this often is administered before, not after, surgery.

Postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication would the nurse suspect the client is experiencing?

Hypocalcemia The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy commonly results in a parathormone deficiency and decreased serum calcium levels. Hypokalemia is characterized by generalized weakness, diminished reflexes, shallow respirations, and cardiac dysrhythmias. Thyrotoxic crisis is characterized by tachycardia, hyperpyrexia, and an exacerbation of hyperthyroid symptoms. Hypovolemic shock is characterized by a weak, thready pulse and hypotension.

Which assessment findings would indicate the need for atenolol in a client diagnosed with hyperthyroidism?

In hyperthyroidism, atenolol is prescribed to reduce cardiac manifestations. Tachycardia, atrial fibrillation, and systolic hypertension are cardiac manifestations associated with hyperthyroidism. Distant heart sounds are associated with hypothyroidism. The cardiac output is increased in hyperthyroidism. 1. tachycardia, A-fib, systolic hypertension

client with hyperthyroidism is about to receive methimazole, as nurse what information should you provide the client?

Initial improvement will take several weeks. Methimazole blocks thyroid hormone synthesis; it takes several weeks of medication therapy before the hormones stored in the thyroid gland are released and the excessive level of thyroid hormone in the circulation is metabolized. There are many common side effects that include nausea, vomiting, diarrhea, rash, urticaria, pruritus, alopecia, hyperpigmentation, drowsiness, headache, vertigo, and fever. Methimazole should be spaced at regular intervals because blood levels are reduced in approximately 8 hours. Large doses cause toxic side effects that can be life threatening, including nephritis, hepatitis, agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, and lymphadenopathy.

signs and symptoms might the nurse identify when assessing a client with hyperthyroidism?

Menstrual irregularities are due to hypothalamic or pituitary disturbances associated with both hyperthyroidism and hyperthyroidism. The skin is warm and flushed because of a hyperdynamic circulatory state. A short attention span is related to altered cerebral metabolism from excess thyroid hormones. Hypertension is associated with hyperthyroidism; hypotension is associated with hypothyroidism. Facial edema is not related to hyperthyroidism. Hypothyroidism is associated with decreased renal blood flow that results in fluid retention (e.g., peripheral and facial edema). 1. menstrual irregularities, flushed appearence, short attention span

A client with hyperthyroidism asks the nurse about the tests that will be ordered. Which diagnostic tests would the nurse include in a discussion with this client?

Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T3) A decreased TSH assay together with an elevated T3 level may indicate hyperthyroidism. X-ray films will not indicate thyroid disease, and elevation of T4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG) and is inadequate for diagnosis when used alone. Po2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.

Which measures would the nurse include when teaching a client with hyperthyroidism how to manage the discomfort associated with exophthalmia? Select all that apply. One, some, or all responses may be correct

Tinted glasses decrease light on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly 1. use tinted glasses, elevated HOB 45 degrees, tape eye lids shut at night if they don't close

observable symptoms of surgically induced hypothyroidism (3)

dry skin, lethargy, sensitivity to cold (insomnia and tachycardia are associated with hyperthyroidism).

A client is diagnosed with hyperthyroidism, and surgery is scheduled because the client refuses ablation therapy. While awaiting the surgical date, which instruction would the nurse teach the client?

teach: Eliminate coffee, tea, and cola from the diet. Coffee, tea, and cola contain caffeine, which may increase thyroid activity. Hyperactivity is a physiological response; it is not under conscious control. The increased metabolic rate associated with hyperthyroidism will make the client feel warm; a cool environment is needed. Hyperactivity is a problem, and the client should be encouraged to rest.